Although NHS trusts have done all they can to prepare for extra winter pressures, the health service is already at or close to full stretch - and patient risk remains - NHS Providers has said.

NHS Provider’s Ready and resilient? How NHS trusts have prepared for winter outlines what has been done o ensure safe, high quality care for patients. Specific actions by trusts include: steps to ensure the seamless flow of patients through to discharge; local resilience plans with partner organisations such as social care services; support to ensure people with mental health needs are treated in the right place; initiatives that make it easier for staff to do the right thing; and communications to complement the ‘Stay well this winter’ national campaign.

Significant steps taken at a national level to improve NHS resilience include: a more joined-up approach; contingency plans to support trusts at greatest risk of having difficulties this winter; extension of primary care streaming in emergency departments to ensure patients are treated in the right setting; and an extra £335 million in the 2017 Budget to help the NHS cope with winter.

While preparations for winter have been more thorough, the report highlights continuing difficulties and pressures that could jeopardise trusts’ ability to cope. They include: lack of beds; shortages of key staff groups; funding pressures; and high cases of flu.

Glen Burley, chief executive, South Warwickshire NHS Foundation Trust and Wye Valley NHS Trust, said: “In South Warwickshire we redesigned our emergency assessment unit to take account of changes that we’ve made over the last few years. That opens in two weeks time. In Wye Valley we’ve been looking at staffing out of hours and at night time particularly to ensure that we’ve got the right staffing to meet demand, and at both trusts we’ve been really focussed on staff flu vaccination. We’ve really high levels.”

Navina Evans, chief executive, East London NHS Foundation Trust, said: “For our mental health patients and service users it is about making sure their care plans and treatment are fit for purpose to see them through the winter: for our acute services making sure that our liaison mental health services support them properly to manage their demand, and that our community services do the same by making sure that we prevent unnecessary admissions and facilitate quick discharge.”

Anthony Marsh, chief executive, West Midlands Ambulance Service NHS Foundation Trust, said: “We have been putting extra paramedics, nurses and GPs into our call centres to be able to deal with more patients over the telephone, thus reducing the number of patients being conveyed to hospital: but also for those patients that do require to be taken to hospital, by supporting the handover process with our acute colleagues, enabling us to free up our ambulances more promptly to respond to further emergency cases in the community.”

Karen Partington, chief executive, Lancashire Teaching Hospitals NHS Foundation Trust, said: “We’ve created something called a ward liaison officer role and those are people who work on each of the wards to support the nursing staff. It takes away some of the administrative roles, chasing up scans, making sure we’ve got the pharmacy in place, and that means the nurses are then free to look after the patients on the wards.”